Some people with chronic obstructive pulmonary disease (COPD) need to use multiple inhaled medicines each day to control their symptoms. Long-acting combination inhalers that contain more than one medicine are changing the way that COPD is treated. Instead of using multiple inhalers multiple times per day, many people are now able to use one inhaler each day to keep their symptoms under control.
One of these new inhalers that contains a combination of long-acting medicines is called Trelegy Ellipta. It is the first inhaler that contains three medicines to treat COPD. You may hear this called “triple therapy.”
How Does Trelegy Ellipta Work for COPD?
COPD is a long-term (or chronic) condition of the lungs that can make it hard to breathe. COPD is an umbrella term that includes two different conditions: emphysema and chronic bronchitis. Some people with COPD have emphysema, some have chronic bronchitis, and some have both conditions. In emphysema, the air sacs in the lungs become damaged and are less able to pass oxygen into the bloodstream. Air can also become trapped in the damaged air sacs, making it harder to breathe over time. In chronic bronchitis, swelling (inflammation) causes the airways to become narrowed. It also causes mucus to build up, clogging the airways.
People with mild COPD may not have any symptoms. But COPD is a progressive condition, which means that symptoms will get worse with time. As COPD worsens, symptoms can include coughing, bringing up mucus, trouble breathing or taking a deep breath, wheezing, and tightness in the chest.
People with COPD may experience a flare-up (or exacerbation). COPD flare-ups can last for days to weeks and may involve coughing more often, bringing up more mucus, having more trouble breathing, and feeling more tired. Although COPD flare-ups have many different causes, some of these flare-ups are caused by certain triggers. Examples of common triggers are:
- Cold air
- Dust
- Infections
- Pollen
- Smoking or inhaling smoke
- Strong smells
- Sudden temperature changes
The key to treating COPD is to control symptoms, reduce the amount of swelling in the lungs, and open up the airways. This makes it easier to breathe.
Trelegy Ellipta contains three medicines that reduce swelling and relax the muscles in the airways.
- Fluticasone furoate is a medicine that reduces swelling. It is an inhaled corticosteroid (ICS).
- Umeclidinium is a medicine that helps the muscles in the airways relax. It is an anticholinergic medicine. You may also hear it called a long-acting muscarinic antagonist (LAMA).
- Vilanterol is another medicine that helps the muscles in the airways relax. It is a long-acting beta-2 agonist (LABA) medicine.
Umeclidinium and vilanterol are both bronchodilators. These two medicines work in different ways to relax the muscles in the airways.
Can Trelegy Be Used Alone for COPD?
Trelegy Ellipta contains three long-acting medicines and should only be used once each day. For some people with COPD, this will be the only inhaler they need to use every day to control symptoms. Do not use other long-acting, daily inhalers unless your doctor provider says that you should.
You should always have access to a rescue inhaler. An example is albuterol. These inhalers give quick relief of symptoms when you are having sudden trouble breathing. Trelegy Ellipta is a maintenance inhaler that should only be used to prevent COPD symptoms. It is not used to manage sudden breathing issues.
How Do I Take Trelegy Ellipta?
You inhale one puff once daily, at the same time each day. After inhaling, rinse your mouth with water and spit the water out into the sink. This is important to lower your chance of getting a yeast infection in the mouth or throat called oral thrush.
There are two strengths. Only one of them is approved by the FDA for treating COPD. Your doctor will decide which dose is best for you.
It is important for you to use the inhaler properly so that you get the right dose. Your prescription should come with instructions for use, which explains how to prepare your dose, inhale the medicine, and when to refill your inhaler. For example, you should not open the cover of the inhaler until you are ready to use it or you may lose the dose. Ask your pharmacist or other healthcare provider if you are unsure how to use your inhaler.
How Was It Studied for COPD?
Three clinical studies were done to see if Trelegy Ellipta was safe and effective for treating COPD. Everyone in the studies had COPD and was at least 40 years old. Most of the people in these studies were male (over 60%). The studies enrolled patients from many different countries, including the U.S.
Two of these studies compared Trelegy to another type of inhaler (Breo Ellipta) that contained two of the long-acting medicines that are in Trelegy, fluticasone furoate and vilanterol.
- The people in these studies had all smoked at some point in their lives, and some were still smoking at the time of the study.
- Efficacy was measured by asking people to take a deep breath and then force as much air out of their lungs as possible. The amount of air that a person could force out of their lungs in one second was recorded. This measure helps to understand how well the lungs are working.
- These studies also looked at how often people needed to use their rescue inhalers.
A third study compared Trelegy to two other types of inhalers that contained two long-acting medicines. One of these inhalers contained fluticasone furoate and vilanterol. The other inhaler contained umeclidinium and vilanterol.
- Most of the people in this study were former smokers (65%).
- All of the people in this study had at least one moderate or severe flare-up within the past year.
- Efficacy was measured by the number of moderate or severe flare-ups that happened during the study.
For all three of these studies, people were told to use their inhaler once each day for 3-12 months. If they had sudden trouble breathing, they were told to use their rescue inhalers. They did not know whether their inhaler had two medicines or three medicines.
What were the benefits?
Breathing function. People who used Trelegy Ellipta were able to force more air out of their lungs than the people who used the other inhaler. This improvement started on the first day of the study and continued through the last day. This means that people were able to move air through their lungs more easily.
Need for rescue inhalers. Two studies counted the number of days where people did not need to use their rescue inhalers. These days were called “rescue-free days.” People who used Trelegy Ellipta had more rescue-free days, on average, than people who used an inhaler with only two long-acting medicines.
Moderate to severe COPD flare-ups. One study counted the number of moderate or severe flare-ups that happened during the study. A “moderate” flare-up meant that a person needed to take antibiotics and/or corticosteroids. A “severe” flare-up meant that a person had to be admitted to the hospital or died. All of the people in this study had at least one of these flare-ups in the year before the study started. People using Trelegy Ellipta for a year had fewer moderate/severe flare-ups than people who used the inhalers with only two long-acting medicines.
COPD symptoms. People in these studies completed surveys to help see how their COPD symptoms were affected. One of the surveys asked patients how often their symptoms happen, including how often they cough, have mucus, have trouble breathing, wheeze, or have chest tightness. It also asked patients how severe these symptoms were, and how much they got in the way of daily activities, such as washing, dressing, walking, household chores, yardwork, and more.
In most of these studies, people who used Trelegy Ellipta were more likely to have improvements in their symptoms than the people who used inhalers that contained only two long-acting medicines.
When Will Trelegy Start Working?
You should have less trouble breathing after using it for a few days or weeks. For some people, this might mean that there will be fewer sudden breathing issues and that you will not need to use your rescue inhaler as often.
Do not stop using it without talking to your doctor first, even if your breathing has gotten better. Your breathing may get worse again once you stop it. Tell your healthcare provider if it is not easier to breathe after a few weeks. Your healthcare provider may ask you to show them how you use your inhaler to be sure you are using it properly. Otherwise, you and they can discuss other options for treating COPD.
Contact your doctor right away if your breathing problems get worse or if you need to use your rescue inhaler more often than before. You should also contact them right away if your rescue inhaler doesn’t seem to work as well as it did before.
How to Prevent and Manage Side Effects
The most common side effects are infections of the airways. These include infection in the nose or throat, a sore throat, or common cold symptoms. This can also include lung infections, such as bronchitis or pneumonia. The best way to prevent infection is to reduce your exposure to germs by washing your hands and avoiding people who are sick. You should also stay current on vaccinations, such as getting an annual flu vaccine.
You can sometimes get a yeast infection in the mouth or throat called oral thrush. The best way to prevent this infection is to rinse your mouth with water after each dose and then spit the water out into the sink.
These are not all of the possible side effects. Talk with your healthcare provider if you are having symptoms that bother you. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088. In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.
Are There Any Drug Interactions?
Several medicines can affect the blood levels of the ingredients in Trelegy and increase the risk of side effects. Tell your doctor if you are taking the antibiotic clarithromycin, any medicines for HIV, or any medicines for a fungal infection. Also tell your doctor if you are using any medicines for heart problems or blood pressure.
Many other inhalers for COPD contain medicines that are the same as or similar to the medicines in Trelegy Ellipta. You may need to stop an inhaler that you were taking before if you switch to Trelegy. Talk with your doctor if you are unsure which inhalers to use daily or as needed.
This is not a complete list of interactions. Tell your pharmacist or doctor about all the prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, or other supplements you take or have recently taken.
Is There a Cost-Savings Program?
There is a coupon available from the manufacturer that may allow you to pay $0 for your prescription. Whether you are eligible depends on whether you have prescription insurance and what type of insurance you have. You can find out more at https://www.trelegy.com/savings-and-coupons/.
